László Környei

Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease

BackgroundChronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction.MethodsA group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram.ResultsLeft ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation.ConclusionChronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.

A szénhidrátszegény transzferrin szintje a magyarországi népességben a nem és kor viszonylatában

A rendszeres alkoholfogyasztas mennyisegenek a megitelese a beteg anamnezisfelvetelekor a beteg elmondasa alapjan rogzithető adat. Sok esetben azonban a betegek az alkoholfogyasztas merteket erdemlegesen nem kozlik orvosukkal, bizonyos esetekben egyszerűen eltitkoljak. Ilyenkor a szenhidratszegeny transzferrin (CDT) mennyisegenek meghatarozasa segithet. Celkitűzes: A szenhidratszegeny transzferrin szintjenek meghatarozasa egeszseges populacioban. Modszerek: A szerzők vizsgalataikat egy magyarorszagi telepules (Enese) lakosainak koreben vegeztek. 409 beteg (atlageletkor: 49,7 ev) adatait dolgoztuk fel. Kozuluk 204 volt ferfi (atlageletkor: 49,3 ev) es 205 nő (atlageletkor: 50,3 ev). A vizsgalt egyeneket ket csoportra osztottuk: 1. alkoholos italt nem vagy csak kismertekben (napi 40 g alatt) fogyasztok; illetve 2. napi 40–60 g-nak megfelelő, ugynevezett tarsasagi ivok csoportjara. A szenhidratszegeny transzferrin mennyiseget immunturbidimetrias modszerrel, Roche/Hitachi Modular P 912 automata keszulekkel (R...The level of carbohydrate-deficient transferrin according to the age and sex in Hungary. The quantity of usual alcohol consumption is a concrete date which can be determined at the anamnesis of patients according to the patientdoctor discussion. In many cases the patients do not inform the doctors in details, in some cases they do want to take it in secret. In these cases the carbohydrate-deficient transferrin can be the most realiable indicator. Aim of the study: determination of the concentration of CDT in healthy population. Methods: The authors carried out their investigations in a small Hungarian town (Enese). 409 individuals (mean age: 49,7 years) were involved in the trial. Among them 204 men (mean age: 49,3) and 205 women (mean age: 50,3 years) were found. The persons were divided into two parts: 1. those who do not drink alcoholic beverages at all or only in small quantities ( < 40 g/day) and 2. those who drink about 40–60 g alcohol/day, as so-called social drinkers. The quantity of CDT was measured by turbidimetric methods with Roche/Hitachi Modular P 912 automatic equipment (Roche, USA). Results: The values of CDT increased with the age of persons in parallel, it was significantly higher in the individuals with the age of 45–65 than in those below 25 years. In female persons under 45 they found significantly lower levels than in male individuals. In social drinkers (between 40–60 g alcohol/day) the values were higher in all the ages, than in persons not drinking alcoholic beverages, and in the age between 45–65 the levels were significantly higher than in the youngers. Among them men had higher values than women. Conclusions: The value of CDT increases with the age, social alcoholic consumption does enhance the concentration, too.UNLABELLEDnThe quantity of usual alcohol consumption is a concrete date which can be determined at the anamnesis of patients according to the patient-doctor discussion. In many cases the patients do not inform the doctors in details, in some cases they do want to take it in secret. In these cases the carbohydrate-deficient transferrin can be the most reliable indicator.nnnAIM OF THE STUDYnDetermination of the concentration of CDT in healthy population.nnnMETHODSnThe authors carried out their investigations in a small Hungarian town (Enese). 409 individuals (mean age: 49.7 years) were involved in the trial. Among them 204 men (mean age: 49.3) and 205 women (mean age: 50.3 years) were found. The persons were divided into two parts: 1. those who do not drink alcoholic beverages at all or only in small quantities (< 40 g/day) and 2. those who drink about 40-60 g alcohol/day, as so-called social drinkers. The quantity of CDT was measured by turbidimetric methods with Roche/Hitachi Modular P 912 automatic equipment (Roche, USA).nnnRESULTSnThe values of CDT increased with the age of persons in parallel, it was significantly higher in the individuals with the age of 45-65 than in those below 25 years. In female persons under 45 they found significantly lower levels than in male individuals. In social drinkers (between 40-60 g alcohol/day) the values were higher in all the ages, than in persons not drinking alcoholic beverages, and in the age between 45-65 the levels were significantly higher than in the younger groups. Among them men had higher values than women.nnnCONCLUSIONSnThe value of CDT increases with the age, social alcoholic consumption does enhance the concentration, too.

Levels of carbohydrate-deficient transferrin according to gender and age in a small town in Hungary.

Abstract Abstract The estimated amounts of alcohol consumed regularly are data recorded on the basis of patients’ self-report at history-taking. In many instances, however, patients do not genuinely inform their physician on the extent of their alcohol consumption, and in some cases they simply conceal it. In such cases determination of the amount of carbohydrate-deficient transferrin (CDT) can be helpful. Objective To determine the levels of carbohydrate-deficient transferrin in a healthy population. Methods The authors performed examinations among inhabitants of a small Hungarian town (Enese). Data of 409 individuals (average age: 49.7 years) have been processed. They included 204 men (average age: 49.3 years) and 205 women (average age: 50.3 years). Subjects were divided into two groups: 1) those who consumed no alcohol or only small quantities (< 40 g/day) and 2) the so-called social drinkers who consumed an amount corresponding to 40 to 60 g alcohol/day. Levels of carbohydrate-deficient transferrin w...

Ice mapping during tachycardia in close proximity to the AV node is safe and offers advantages for transcatheter ablation procedures.

Background — Ablation during ongoing orthodromic reentry tachycardia (AVRT) and atrioventricular nodal reentry tachycardia (AVNRT) is not recommended using radiofrequency energy when the arrhythmia substrate is located in close proximity to the atrioventricular (AV) node due to a significant risk for inadvertent AV block. The aim of the study is to test the feasibility of ice mapping during tachycardias involving arrhythmia substrate located in close proximity to the AV node. Methods — This was a single-centre, prospective, randomized study. A total of 65 patients was screened and 30 patients with supraventricular arrhythmias were assigned either to a cryo or RF energy group after diagnosis of AVNRT (17 pts) or AVRT (13 pts) with an anteroseptal accessory pathway. RF ablation was performed using standard ablation techniques. In the cryo group, ice mapping was performed during tachycardia with cooling of the catheter tip temperature to a maximum of —40°C. Ablation was performed only if ice mapping terminated the tachycardia without prolongation of the AV conduction. Results — The overall acute success rate was 84%, and was not different in the cryo and RF groups (85% vs. 82.4%, P = 0.43). Both fluoroscopy and the procedure times were comparable.There was a marked reduction in the mean number of applications in the cryo group [2 (1-6) vs. 7 (1-41), P = 0.002]. In one patient ablation was not attempted in the cryo group because of AV prolongation, and in two patients temporary second-degree AV block was observed in the RF group. After 12 months follow-up the long-term success rate was similar between the two groups. Conclusions — (1) Ice mapping is a feasible method to determine the exact location of accessory pathways and of the slow pathway during tachycardia. (2) Ice mapping performed during tachycardia causes less ablation lesions without increasing the procedure and fluoroscopy times.

Szénhidrátszegény transzferrinvizsgálat eredményei munkahelyi vegyszer-expozíció után

UNLABELLEDnCarbohydrate-deficient transferrin (CDT) examinations have been used with those people who regularly consume more than 60 gr. of alcohol in a day, especially in cases of medical insurance. In these cases the CDT provides information even 2-3 weeks later.nnnAIM OF THE STUDYnIn adequate literature there are not many informations concerning the CDT values in individuals using chemicals. This is why these cases are interesting for demonstration.nnnCASE REPORTnIn the first case the examination of CDT was carried out one month after using the chemical material -- nitro-based lacquer -- and its value was increased. In the other case an agricultural man worked on a tractor spreading plant-protecting chemicals. Six months after finishing this type of work similar results were found: highly increased value of CDT.nnnCONCLUSIONnAs both these people were documented to be abstinent for alcoholic beverages, it is rather likely that the values of CDT can be the signal of increased chemical exposure. With the proceeding of the CDT examinations it is necessary to look forward to the potentials of the revealing of the chemical exposure. The authors suggest that the CDT value in workers with chemical exposure can show the pathological changes caused by these substances.

Management of paediatric arrhythmias in Europe

We read with great interest the EP wire report entitled ‘How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm Survey’ by Hernandez-Madrid et al .1 On behalf of the Arrhythmias and Electrophysiology Working Group of the Association for European Pediatric and Congenital Cardiology (AEPC), we would like to comment on the methodology and content of the article.nnThe EHRA Research Network Centers do not include any of the dedicated paediatric centres providing interventional electrophysiological therapy. This creates a major sampling error and negates the validity of the conclusions of the …

Treatment of arrhythmias associated with congenital heart disease using transcatheter ablation

disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progres sion of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappo inting.Aimandmethods: In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.Results: During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients re quired redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the interven tion. In four patients minor complications occured (small hematomas).Conclusions: Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly cu rative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.UNLABELLEDnRhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing.nnnAIM AND METHODSnIn the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.nnnRESULTSnDuring this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas).nnnCONCLUSIONSnOur descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.

Veleszületett szívbetegséghez társuló ritmuszavarok katéterablatiós kezelése

disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progres sion of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappo inting.Aimandmethods: In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.Results: During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients re quired redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the interven tion. In four patients minor complications occured (small hematomas).Conclusions: Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly cu rative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.UNLABELLEDnRhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing.nnnAIM AND METHODSnIn the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.nnnRESULTSnDuring this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas).nnnCONCLUSIONSnOur descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.

Slow and wide QRS complex tachycardia as a unique complication following radiofrequency catheter ablation of a left-sided accessory pathway in a child

Radiofrequency lesions can, theoretically, be the substrate for new persistent arrhythmias. As far as we know, this has never previously been encountered after transcatheter ablation of accessory pathways. A child with Wolff-Parkinson-White syndrome was referred for radiofrequency catheter ablation of a left-sided accessory pathway. After successful ablation of the accessory pathway using a retrograde transaortic approach, the child developed an incessant wide QRS complex tachycardia at slow rate that was resistant to pharmacologic interventions. The focus of the tachycardia was identical to the ventricular site of insertion of the eliminated accessory pathway.

Treatment of arrhythmias associated with surgery for congenital heart disease using transcatheter ablation

disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progres sion of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappo inting.Aimandmethods: In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.Results: During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients re quired redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the interven tion. In four patients minor complications occured (small hematomas).Conclusions: Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly cu rative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.UNLABELLEDnRhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing.nnnAIM AND METHODSnIn the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.nnnRESULTSnDuring this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas).nnnCONCLUSIONSnOur descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.